| NPI | 1295976132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 1918) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0003053) |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2024-01-03 |